Palliative Care

Introduction

The Palliative Care Movement is based mainly on the modern Hospice Philosophy concerning end-of-life care, its main exponent being the St. Christopher Hospice, founded by C. Saunders. She explains (Sanders, 1993) the two key points that form the nucleus of this philosophy:

• ‘the message is: you matter because you are you, and you matter until the last moment of your life. We will do all we can, not only to help you die peacefully, but also to live until you die.’
• the concept of Total Pain (including physical, psychological, social and spiritual elements).

The author also lists the elements that St. Christopher's brought together to set up this work: (a) beds integrated in local community; (b) development and monitoring of symptom control; (c) family support; (d) bereavement service; (e) home care; (f) research and evaluation; and (g) education and training.

There are also some key events that have promoted the expansion and consolidation of this care system:

• The work by Kübler-Ross, using a large series of interviews with terminal patients talking about dying, and reflected in her famous book On Death and Dying. This had a huge impact on the public and on many health professionals in the 1960s.
• The beginning of the movement in the USA, in 1974, headed by S. Lack, and its subsequent impact of home care in this country; not long thereafter the same resources were adopted in the UK.
• The first use of the term ‘palliative care’, as a non-stigmatizing one, by B. Mount, who opened the Palliative Care Service at the Royal Victoria Hospital in Montreal, and its subsequent introduction in other countries.
• In 1987, Palliative Medicine was recognized as a medical speciality in the UK.
• In 1990, the WHO stated that the correct term for this system of care is ‘Palliative Care’, offering a useful definition thereto: ‘The active total care of patients whose disease is not responsive to curative treatment, control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are also applicable early in the course of the illness in conjunction with anticancer treatment.’

And as Doyle et al. (1993) have emphasized, WHO adds: ‘Palliative care … affirms life and regards dying as a normal process … neither hastens nor postpones death … provides relief from pain and other distressing symptoms … integrates the psychological and the spiritual aspects [Page 672]of care … offers a support system to help patients live as actively as possible until death … offers a support system to help the family cope during the patient's illness and in their own bereavement.’ As we can see, this implies:

• continuity of care
• multidisciplinary, global care
• family care.

Palliative care researchers and clinicians point out that the main aim of palliative care is to provide as much comfort and/or well-being as possible for patients and families. This, however, is not a simple task, and if we delve deep enough, we can detect many questions that are difficult to answer; in this entry, I will try to point out some considerations about them, justifying the need for assessment, and the areas that we must take in to account to do so appropriately.

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